Anonymous wrote:Hi, dealing with secondary infertility. I have preschool age son and had a missed miscarriage at 12 weeks this fall. In the middle of testing now and trying to figure out my next steps. So far, everything coming back "good". 19 follicles, AMH of 2.9, HSG was clear. I know I should wait for a consult with my dr to figure this out, but I am so impatient. What would your treatment path be in this scenario? Jump right to IVF? Try an IUI or two first? IUI is covered by insurance and IVF is self-pay. I am 39 and DH is 41. Thanks for any input.

Hi, in your shoes five years ago I went directly to IVF just because I didn't feel like waiting or trying suboptimal approaches like IUD. Our numbers were good and we would probably have had a natural pregnancy if we tried long enough but I just couldn't bother. Went directly to IVF and had enough eggs/embryos for two pregnancies.

One factor is that our insurance covered IVF completely.

Since you have no idea how you’ll respond, shared risk sounds like the way to go. And at 39, you won’t be eligible for the plans much longer.

OP again - the doctor gave us an 87% chance of taking home a baby after three cycles. I assumed we would do shared risk so we just had to deal with the money thing one time and not think about it again - but I am still learning, should I be thinking about it differently?

OP here - thanks for all the replies. We are going to skip IUI and go right to IVF. We finished all our testing two weeks ago and just met with the doctor (virtually). Starting to schedule/plan now.

Another reason to go straight to IVf is your age. There is an age related cutoff for IVF, after which point your only option is donor egg route, which is WAY more expensive. I speak from experience, having successfully gone thru IVF at Shady Grove when I was (well) over age 42. Also, at your age, IVF does not have to be expensive, there are different plans, the most expensive being the Shared Risk program, which refunds your money if not successful but is expensive if you succeed on the first or second try. If you paid per round kit wouldn’t be that expensive - ie several thousand vs potentially tens of thousands.

I did four IUIs and I find IUIs to be a massive waste of time and energy. I used donor sperm so also a massive waste of money. Just waiting until insurance covers IVF.

I would go straight to IVF for the only reason that you can test the embryos. You can probably get pregnant again naturally but are risking more miscarriages. I'm sorry for your loss.

Here's an article with a graph on miscarriages.

https://www.google.com/amp/s/expectingscience.com/2015/09/22/age-and-the-risk-of-miscarriage/amp/

I also read in a science journal that people who have had a miscarriage before have a higher chance of getting another one.

If you were my sister or friend, I'd tell you that unless you can absolutely not afford IVF (in which case you can't afford to raise that child either right now), that I'd try to minimize the miscarriage risk by not wasting time with IUIs. Raising a child costs so much. If the cost difference between IVF and IUI is hindering you, I'm not sure how ready you are to go through the costs of potentially multiple fertility rounds.

OMG, do IVF!!!! Don't waste time and money on IUIs at age 39. My doctor friend who had gone through several IVF cycles herself recommended I skip IUI at my age of 35. Considering one might have to do several IVF cycles, don't waste time with IUIs.

Look up how miscarriage rates go up after around 41/42. You don't want to end up there.